A big part of living with the skin condition known as hidradenitis suppurativa (also known as HS or acne inversa) is paying attention to details in your day-to-day life: What factors seem to make new cysts appear, or existing ones intensify? Much like migraine headaches, hidradenitis suppurativa flare-ups can have very specific triggers—factors in your environment, diet, or lifestyle that cause your symptoms to start. Similarly to people living with migraine, people living with HS often have to play detective and go through some trial-and-error to identify what their triggers are. A skin disease that involves the immune system, the cause of hidradenitis suppurativa is unknown (it likely involves some combination of genetic predisposition and hormones), but it can definitely get better or worse in response to external factors. Your dermatologist can help you figure out what your potential triggers may be, but as a starting point, here are a few of the most common triggers of HS to be mindful of after a diagnosis.
Tight clothing
Loose-fitting clothes are the best bet for people with HS, as they reduce friction and allow air to circulate and sweat to dissipate. If you get lesions on your groin area or buttocks, cotton boy shorts or men’s boxer briefs are good breathable, friction-minimizing options, and some people even try to go underwear-free when possible during a painful flare-up. All of that said, sometimes snug clothes can be helpful too. To protect high-friction areas of skin like the inner thighs, some people with HS prefer bike-short style underwear, or to wear leggings to work out. Just be sure to change right afterward if you get sweaty.
Scrubbing
It might seem like scrubbing your skin would help deep-clean it and exfoliate away HS, but this skin condition has nothing to do with poor hygiene, and overzealous washing tends to have the opposite of the desired effect. Loofahs and scrubs can cause irritation that leads to flare-ups and new lesions. The best way to avoid showers becoming a hidradenitis suppurativa trigger: Stick to a gentle, fragrance-free body wash or an antimicrobial/antiseptic or anti-acne body wash, and use your hands to lather it up.
Shaving
As with scrubbing, shaving can cause inflammation that worsens HS symptoms. Some people with hidradenitis suppurativa forgo shaving affected areas for this reason, at least when they have a flare-up. Others invest in laser hair removal, which in addition to eliminating the need for irritating shaving, has a high success rate in helping reduce or even eliminate symptoms of hidradenitis suppurativa (it zaps the hair follicles that can become clogged and form cysts). Ask your dermatologist if you’d be a good candidate for this; note that you’ll likely need at least three sessions to see results, and it can be costly.
Sweat
Hidradenitis suppurativa happens when hair follicles and sweat glands become clogged with bacteria, so letting your skin marinate in sweat can trigger lesions, especially in zones like your under-breast area. Choose loose-fitting clothes for exercise when possible, and after you work out, change out of sweaty clothes promptly and shower or use gentle cleansing wipes on key areas of skin). Counterintuitively, some people with HS find that antiperspirants make their armpit sweat glands more clogged and trigger flare-ups. Read on to the next tip for some alternative armpit tactics.
Deodorant
Many people with HS find deodorant triggering, especially gel formulas and those with strong scents. At the same time, finding an effective way to minimize armpit sweat can help with HS symptoms. Some people have better luck with sprays, first applying Vaseline or Aquaphor to any existing lesions to prevent stinging. Another option: Wash your armpits with antibacterial soap in the morning, then keep fragrance-free wipes on hand to freshen up with throughout the day; you can put some witch hazel on the wipe to kill bacteria and calm inflammation. Some people with HS swear by using feminine wipes to refresh their armpits. If you really want to wear deodorant, try natural crystal deodorant or mild, unscented stick formulas with short ingredient lists, which tend to be less irritating. Your dermatologist can recommend good options, too.
Skincare products
Deodorant isn’t the only topical HS trigger you might be unknowingly applying to your skin. Any personal care product has the potential to trigger symptoms of hidradenitis suppurativa, especially those that contain alcohol, parabens, dyes, baking soda, and fragrances, according to the American Academy of Dermatology. It’s best to stick to items with descriptors like "sensitive” and “fragrance-free”. The organization HS Connect compiles a great list of specific personal care products for HS that people find non-triggering and helpful, from brands of bandages to bath products and deodorants.
Smoking
Smoking is one of the best-known risk factors for developing hidradenitis suppurativa. It is also associated with more severe cases of HS. Many dermatologists believe that stopping smoking can reduce the severity and frequency of flare-ups and even put the skin disease into remission (although clinical evidence confirming that quitting smoking eases HS symptoms is still limited). Smoking is also closely associated with other skin conditions that involve the immune system, like psoriasis. Thus, if you have HS, it seems worth the effort to quit smoking and see how your skin responds after a few months. (And anyone with a family history of hidradenitis suppurativa should definitely avoid taking up smoking to begin with.) Here are some therapist tips for quitting smoking; maybe 2025 is the year you make it happen.
Obesity
Along with smoking, obesity is a top trigger for developing this skin disease, and being overweight can also make it harder to manage flare-ups, since skin folds create friction and inflammation that can exacerbate symptoms of hidradenitis suppurativa. Obesity is also associated with more severe cases of HS and, in turn, further diminished quality of life. Weight-loss isn’t always a solution—or an option—but it’s worth a conversation with your doctor.
Certain foods
Some people are able to identify specific dietary triggers that make their hidradenitis suppurativa symptoms worse; common ones include sugary foods and refined carbs/baked goods, high-fat dairy products (cheese, ice cream, butter), alcohol, and brewer’s yeast. It can be worth trying an elimination diet to identify your own food triggers. The big picture of your diet also matters. For example, eating too many highly processed foods can negatively impact your gut microbiome, increasing inflammation in your body that can trigger HS. One of the best diet approaches, according to research recently published by the Hidradenitis Suppurativa Foundation, is the Mediterranean diet, which focuses on fresh fruits and vegetables, legumes, nuts, whole grains, fish and poultry, and extra-virgin olive oil, with minimal red meat. “Using extra virgin olive oil as the main fat for cooking, and eating poultry rather than red meat played the most important role in reducing HS severity,” the study concludes.
Stress
Stress triggers inflammation in the body that can make all sorts of medical issues worse, including this skin condition, which some researchers categorize as “autoinflammatory”. Of course, having symptoms of hidradenitis suppurativa is, in and of itself, stressful. It’s important to stay focused on your mental health and quality of life and seek support when you feel overwhelmed. The good news is that there are many new treatment options for HS coming out, and more in clinical trials. Talk to your dermatologist about which ones might work for you. And if you’re stressing out or having trouble sleeping due to symptoms of hidradenitis suppurativa, your healthcare provider should be able to help you find solutions—because of the ways it helps balance your hormones and heal your skin, getting a good night’s rest is one of the best anti triggers of HS.
